Tobacco use remains the nation's leading preventable cause of death. High quality aggressive tobacco control programs not only prevent tobacco use and disease, but can be an important component of health care cost containment, a key policy concern at all levels of government and in the private sector. All tobacco control programs are not equally effective in terms of reducing smoking or health care costs savings per dollar spent. In addition, the tobacco industry works to stop or blunt these programs'effectiveness. This project will use a combination of qualitative and quantitative methods to accomplish three Specific Aims: 1. Document and analyze the variations in tobacco control policymaking and program implementation, including evolving tobacco industry strategies, in states with varying levels of success at developing and implementing tobacco control programs, to serve as the basis for recommendations to create the most effective and efficient tobacco control strategies and policies. 2. Define the relationships between state tobacco control program spending, smoking, and health care expenditures and use these relationships to quantify the effects of program intensity and quality. 3. Quantify the effects of tobacco control policies on smoking initiation, progression and cessation, and health disparities. We will pursue Aim 1 through a series of detailed case studies of the development and effects of state tobacco control policies and programs. We will pursue Aim 2 using modern econometric methods (based on cointegrating regressions) to quantify the effects of these programs on smoking behavior and, in turn, the effects of smoking on health care costs. For Aims 2 and 3, we will merge national datasets (the National Longitudinal Survey of Youth and the Tobacco Use Supplement of the Current Population Survey) with policy data on clean indoor air laws, tobacco taxes, price and demographic variables to develop new models of smoking behavior that will provide a framework for understanding how these policies affect individual behavior and health disparities. The resulting knowledge will increase the likelihood of successfully developing and implementing effective tobacco control policies by providing information to public health officials and advocates on how to maximize program effectiveness and, equally important, understand how to ensure that health authorities use increasingly limited resources to support the most effective interventions. PUBLIC HEALTH RELEVANCE: Tobacco use remains the nation's leading preventable cause of death. High quality aggressive tobacco control programs not only prevent tobacco use and disease, but can be an important component of health care cost containment, a key policy concern at all levels of government and in the private sector. All tobacco control programs are not equally effective in terms of reducing smoking or health care costs savings per dollar spent. This research will contribute to our knowledge of how to maximize program effectiveness and, equally important, understand how to ensure that health authorities use increasingly limited resources to support and defend the most effective interventions.